Combining opioid painkillers, including hydrocodone, codeine, tramadol, and oxycodone, with CYP2D6-inhibiting antidepressants, which include paroxetine, fluoxetine, and citalopram, may lead to adverse outcomes for older nursing home residents, according to US researchers. Their study found a link between using these drugs in combination and a higher risk of worsening pain, and higher incidence rates for pain-related hospitalisation, pain-related emergency department visits, and the development of opioid use disorder. Nursing home residents who are taking opioid painkillers should be prescribed other types of antidepressants, the authors conclude.
Journal/conference: Annals of Internal Medicine
Link to research (DOI): 10.7326/M23-3109
Organisation/s: Ohio State University, USA
Funder: National Institute on Aging.
Media release
From: American College of Physicians
Co-use of CYP2D6-metabolized opioids and antidepressants associated with adverse events in older nursing home patientsA target trial emulation study found that concomitant use of CYP2D6-metabolized opioids (hydrocodone, codeine, tramadol, and oxycodone) with antidepressants was associated with adverse outcomes among older nursing home residents. This is important because opioids metabolized by the cytochrome P450 (CYP) 2D6 (CYP2D6) enzyme are commonly prescribed among older adults, including those living in nursing homes. In fact, more than one-third of Medicare nursing home (NH) residents (the population studied in this trial) with chronic pain received prescription opioids concurrently with antidepressants between 2011 and 2015. The findings are published in Annals of Internal Medicine.Researchers from The Ohio State University used a target trial emulation design to investigate the associations of concomitant use of CYP2D6-metabolized opioids and antidepressants with clinical outcomes and opioid-related adverse events (ORAEs) in older Medicare recipients. The authors used a 100% NH sample linked to Medicare claims for long-term residents aged 65 years and older receiving CYP2D6-metabolized opioids with a disease indication for antidepressant use and looked for worsening pain, physical function, and depression from baseline and incident rates of pain-related hospitalizations and emergency department (ED) visits, opioid use disorder (OUD), and opioid overdose. They found that the use of CYP2D6-metabolized opioids concomitantly with CYP2D6-inhibiting (vs. CYP2D6-neutral) antidepressants was associated with a higher risk for worsening pain and higher incidence rates for pain-related hospitalization, pain-related ED visit, and OUD, with no difference in physical function, depression, and OD. According to the authors, these findings suggest that when co-use of opioids and antidepressants is clinically needed, selecting CYP2D6-neutral antidepressants (such as citalopram and sertraline) may provide better or equal clinical and adverse outcomes.
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